The edition · Orthopaedics
The quadriceps graft is being reoperated on twice as often
Across 5653 primary anterior cruciate ligament reconstructions, quadriceps tendon autografts came back to theatre for extension deficit or pain at 11.9% against 5.5% for hamstring; a slope of 15 degrees means a 37% rerupture risk at 18 and 4% at 45; and physician-scored shoulders read 14 points better than the patient's own verdict.
The edition in brief
Four findings for orthopaedic practice. A retrospective cohort of 5653 primary anterior cruciate ligament reconstructions performed between 2015 and 2022 found quadriceps tendon autografts had a 19.2% overall non-revision reoperation rate against 8.9% for hamstring and 6.9% for bone-patellar tendon-bone, driven by reoperation for extension deficit or pain (11.9% vs 5.5% and 4.7%); adjusted odds ratio 1.96 (95% CI 1.44 to 2.67). Quadriceps grafts also had lower odds of achieving minimal important change and of reaching the patient acceptable symptom state. In 581 patients followed at least six years, posterior tibial slope raised rerupture odds by 1.28 per degree (95% CI 1.10 to 1.47) and each year of age lowered them by a factor of 0.91 (0.87 to 0.95), with no interaction - so the relative effect of slope is constant while the absolute risk collapses with age, from 36.6% at 18 to 3.9% at 45 for a slope of 15 degrees. In 302 two-stage revision hip arthroplasties using an articulating high-dose antibiotic spacer, five-year survival free of reinfection was 89%, and spacer dislocation raised the odds of dislocation after reimplantation more than six-fold. A study of 74 shoulders after proximal humerus fixation found the Constant-Murley score ran a mean 14.2 points above the patient's own shoulder subjective value, with pain the only independent predictor of a poor self-rated outcome. And a JBJS perspective sets out three things an orthopaedic surgeon can do to keep older patients out of hospital.
Quadriceps grafts and the return to theatre for a stiff, sore knee
Quadriceps tendon autografts were reoperated on for extension deficit or pain in 11.9% of cases against 5.5% for hamstring (adjusted odds ratio 1.96, 95% CI 1.44 to 2.67), with worse patient-reported outcomes at two years.
Your Constant score is 14 points more optimistic than your patient
The Constant-Murley score ran a mean 14.2 points above patients' own rating of their shoulder after proximal humerus fixation, and only pain - not restricted movement or weakness - independently predicted a poor self-evaluated outcome.
The same slope means something different at 18 and at 45
Posterior tibial slope raised rerupture odds by 1.28 per degree regardless of age, but absolute risk fell from 36.6% at 18 to 3.9% at 45 for a 15 degree slope - so age, not the odds ratio, decides whether slope matters for this patient.
Antibiotic spacers hold at five years, and the ones that dislocate keep dislocating
Articulating high-dose antibiotic spacers in two-stage hip revision gave 89% five-year reinfection-free survival, but spacer dislocation raised the risk of dislocation after reimplantation more than six-fold (hazard ratio 6.2, 95% CI 2.3 to 16.9).
Treat a lost terminal extension as an emergency of the calendar
Measure terminal knee extension in degrees at every early visit after ligament surgery and escalate if it has not improved across two consecutive visits in the first six weeks - the deficit gets harder to reverse the longer it stands.
Three things to do before the older patient leaves your clinic
Give older patients a written prescription for strengthening and balance training, screen them for malnutrition, and take responsibility for bone health optimisation - three clinic-level actions that outlast the surgical episode.
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